Managing Pain During Labor

There are many choices you and your health care provider can make to control your pain.

Before your delivery, you can also learn techniques to control pain without medicines. Learn more on our Comfort Strategies page or explore our pregnancy and birth classes.

Many factors affect the choice of pain relief during labor. It's important to talk with your health care provider during your prenatal visits about which pain control options are best for you and your baby.

You and your healthcare provider will make the final decision about which pain control option is best for you when you are in labor at the hospital.

Medicines used during labor should provide pain relief but still leave you alert and able to enjoy the birth of your baby. Several types of medicines may be used during labor.

When your healthcare provider chooses medicine for pain relief during labor, he or she will consider:

• The effect of the medicine on mother and baby
• What type of medicine is best at each stage of labor
• The risks of the medicine to be used
• How much pain control you want
• When the medicine will be given

Analgesics

Analgesics are pain medicines injected by IV or directly into a muscle. These dull your labor pain but may not take it all away. These drugs sometimes make you and your baby sleepy. For this reason they are usually used during early and active labor or before transition.

Local Anesthesia

Local anesthesia is pain medicine that may be injected into the vaginal or perineal area to numb that area if you need stitches after the birth of the baby.

Regional Analgesia

These medicines are injected into the lower back to decrease feeling in the lower areas of your body. The injection is usually given by an anesthesiologist after a labor pattern is established.

Two types are intrathecal anesthesia and epidural anesthesia. Spinal blocks are less common.

Intrathecal Analgesia

This is a one-time injection into the spinal column to relieve the pain of labor. It is most effective during the active phase of labor (4-5 cm). Pain relief lasts 2 to 4 hours. The mother stays awake but has less pain.

The mother may get up and walk but will need to be checked often. A common side effect is itching.

Epidural Anesthesia 

An anesthesiologist will place a small tube into the area outside the spinal column to give the medicine. This area is called the epidural space. An epidural is common when labor is fully established (4-5 cm).

The epidural tube stays in place so the medicine may be given continuously, by patient-controlled button, or a combination of both.

The mother receives good pain control and generally does not feel contractions. She will feel alert and relaxed. Very little medicine reaches the baby.

The mother will need IV fluids and nurses closely watch her blood pressure, breathing and oxygen levels. Labor may progress more slowly, especially during the pushing stage. The mother usually will need to stay in bed.

Since the mother may not feel the urge to urinate, she might have a bladder catheter.

Rarely, some women develop slow breathing rates and/or headaches.

Spinal Anesthesia

A spinal may be used in the case of a cesarean birth if the mother did not already have an epidural in place. It is given by an anesthesiologist into the spinal column in the lower back.

The spinal is most often given in one dose right before delivery. It acts quickly. The mother will feel total numbness in the lower body while remaining alert and awake. About 1 out of 20 women will develop spinal headaches.